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993 surgical site infection aerobic pathogens are isolated over a six-year period (I.1994-I.2000) by the Microbiology Laboratory at University Hospital "Tzaritza Joana". 224 (22.6%) of them are isolated from patients undergoing abdominal surgery in the Emergency Surgery Clinic. The period covers 3 years before the introduction of current single-dose perioperative prophylaxis (i.e. under the conditions of long-term one) as well as the next 3 years following its introduction in the Emergency Surgery Clinic. The changes of pathogens susceptibility patterns to single-dose drug schemes in both hospital elective abdominal surgery and emergency surgery clinics are followed during the whole period. Our microbial susceptibility data support the ecological expedience of single-dose approach categorically.

A comprehensive pathomorphological assessment is done in 385 patients presenting complicated colorectal carcinoma, covering the period 1990 through 1995. The patients are distributed in 4 groups according to stage, with those in stage III being the most numerous--141 cases. The growth pattern of the neoplasm is as follows: exophytic growth--110 cases, ulcerous growth--57, cup-like growth--13, and endophytic growth--205 cases. On establishing metastatic lymph nodes within I and II lymph collectors, prophylactic postoperative chemo- and immunotherapy are undertaken. In case of lymph nodes present in III lymph collector, the operation is taken to be relatively radical, and for that reason chemo- and immunotherapy assume a therapeutic character.

Twenty-seven cases of perforation, produced by primary colorectal carcinoma over the period 1993-1998, are described. The underlying causes of colorectal carcinoma complication and types of perforations observed are discussed. This is a report on personal experience with the therapeutic approach and operative management of this severest complication of colorectal carcinoma.

Over the period 1993-1998, a total of 385 patients with complicated colorectal cancer are subjected to treatment in the clinic of emergency surgery--University Hospital "Queen Giovanna", Sofia. Obturation is the commonest form of complication--43.8 per cent, perforation within the tumor or diastasis noted in 27 cases (7.01%), paratumor abscesses and infiltrates--in 8.3 per cent and rectohemorrhage--in 4.2 per cent. The therapeutic and operative approach, and the scope of surgery are dependent on a multitude of factors which should be given due consideration by the surgeon. In each patient presenting complicated colorectal carcinoma it is mandatory to make a precise and individual choice of the extent of operative intervention, consistent with the patient's general condition and contributing to eliminate the life-endangering underlying cause.

Colorectal cancer survival depends on: stage of primary neoplastic process development, clinical complication pattern and clinical course of the disease, type (radicalism) of the surgical intervention done and histological verification of blastoma. As shown by the results, postoperative lethality in complicated colorectal carcinoma cases amounts to 17.1 per cent, whereas in those undergoing radical surgery for uncomplicated carcinoma it amounts to 6.8 per cent. Patients presenting complicated colorectal carcinoma are admitted to the clinic with diagnosis advanced stage of development of the disease which explains the lower survival rate. The studies performed show that five-year survivorship in patients with complicated colorectal carcinoma amounts to 33.3 per cent, while among those operated for uncomplicated colorectal carcinoma it is 62.7 per cent in the average.

Unlabelled: The onset of immunological reaction against colorectal carcinoma is based on superficial changes in the malignant cell components following the formation of antigen structures. This explains the interest in the issue and defines the aim of the study. Over a 5-year period, in the Emergency Surgery Clinic, 86 patients with histologically diagnosed colorectal carcinoma (46 men and 40 women) are examined prior to surgery, and 107 patients (55 men and 52 women)--after the operation. The tumor markers CEA, CA 19-9, AFP and immunoglobulin IgA are tested using ELISA and RIA methods. Conventional ultrasound, scintigraphic and CT studies are carried out to detect liver metastases. The obtained results undergo statistical processing with correlation analysis and sensitivity and specificity coefficients. Among those examined preoperatively elevated CEA levels (CEA > 2.5 ng/ml) are recorded in 42 cases (48.9%), and for CA 19-9 (CA 19-9 > 37 E/ml)--in 40 (46.5%). From the patients with complicated colorectal carcinoma in the postoperative period 83 are clinically healthy (77.6%); of the latter marker-positive are 16 (19.3%), and marker-negative--67 (80.7%). Relapses and metastases are registered in 24 cases (22.4%) of which marker-positive--19 (79.2%). Liver and abdominal lymph node metastases are detected by US, scintigraphy and CT study. All three imaging methods contribute to diagnose liver metastases in 14 patients (13%). In 32 patients (18 men and 14 women) postsurgical monitoring of immunological IgA levels and tumor markers is done over period ranging from 7-10 days to 2 years postoperatively. Correlative dependences between IgA and CEA (R = +0.99), and between IgA and CA 19-9 (R = +0.97) are also documented. The sensitivity of both markers (CEA and CA 19-9) is low, varying between 38 and 51 per cent, with specificity amounting to 61-67 per cent. The paradoxically high elevation of tumor markers prior to operation shows a constant decrease at 3 months after surgery., Conclusions: 1. The sensitivity of both markers (CEA and CA 19-9) is low (38-51%), and that is why their use in screening examinations lacks clinical relevance. 2. CEA specificity is by no means high (61-67%), and it may become positive in a number of nononcological diseases (liver cirrhosis and hepatitis, inflammation diseases of GIT and lungs). 3. Plasma CEA and CA 19-9 levels correlate well with the neoplastic process progression/regression. 4. Preoperative CEA level has a prognostic value for postsurgical relapses. 5. High IgA levels are indicators for relapses or metastases from colorectal carcinoma. 6. Tumor histological verification correlates also with the high CEA levels and with the depth of tumor infiltration into the intestinal wall. 7. The dynamic assessment of tumor markers postoperatively has a high informative value in all colorectal carcinoma patients. 8. Pre- and postoperative high CEA levels are observed in patients assigned to the poor prognosis group, and should be given adjuvant therapy.

Proceeding from a comprehensive literature survey the urgency of acute abdomen conditions in elderly and senile patients is thoroughly discussed. Not infrequently, geriatric surgeons face serious difficulties of diagnostic and therapeutic character relating to the severity of clinical picture and elevated postoperative lethality, explaining in turn the great surge of interest in the problem. Recent achievements along this line, surgery in particular, provide for adequate conditions for performing early surgical interventions with reduced intraoperative risk in elderly and old age patients presenting acute abdomen.

Over a one-year period (Nov. 1996-Nov. 1997), a total of 154 patients are admitted on an emergency basis, with deferred emergency and for routine treatment in the Clinic of Emergency Surgery. They are distributed in three groups, as follows: patients not requiring perioperative antibiotic prophylaxis and postoperative antibiotic therapy--27, patients subjected to perioperative parenteral antibiotic prophylaxis under adequate hospital conditions--121, and patients undergoing antibiotic prophylaxis in conditions inappropriate for its application--six. The drug schemes elaborated are in conformity with worldwide and Bulgarian experience along this line, and with the concrete hospital and economical conditions in this country. In all patient indicated for antibiotic prophylaxis the listed below antibacterial agents (presented as drug schemes) are administered i.v. a single time prior to anesthesia induction: in operations on the gastrointestinal tract except for interventions in acute appendicitis: cephalotin/cefazolin 2.0 g and metronidazole 0.5 g i.v.; in operations for acute appendicitis: amoxicillin/clavulanate 1.2 g and petronidazole 0.5 f i.v.; biliary surgery free of extrahepatic cholestasis: cephalotin/cefazolin 2.0 g i.v.; biliary surgery with present or preceding extrahepatic cholestasis: cefotetan 2 g i.v.; contaminated liver cysts (parasitic and nonparasitic): cefotetan 2 g i.v.; abdominal trauma without perforation of a hollow organ: cefotetan 2 g i.v.; in plastic repair of the anterior abdominal wall (congenital defects, postoperative eventration) and in poor risk patients (local and general status: cephalotin/cefazolin 2.0 g i.v. In 135 patients the postoperative period runs a course free of complications worthy of notice. Complications directly linked to introduction of the method proposed are recorded in ten cases: operative wound suppuration (4) and hospital infection (6). Complications not related directly to the procedure are observed in nine cases: urinary tract infection (4), bronchopneumonia (2), fever with unknown source of infection (including negative hemoculture) necessitating additional antibiotic therapy (2) and secondary infection (within a week of intervention) necessitating further therapy with antibiotics. The specific features of antibiotic prophylaxis used in the various types of operative interventions are discussed from microbiological, clinical and pharmacotherapeutic viewpoints. The obtained results are compared with pertinent literature data on the issue with a special reference to the clinical efficacy attained. They mirror the approach against the background of the concrete hospital conditions in this country. The method developed is fully consistent with the level of surgical expertise in Bulgaria. All efforts should be aimed at intrahospital environment improvement by means of meticulous asepsis and antisepsis.

Over a one-year period (November 1996 to November 1997), in the Emergency Surgery Clinic perioperative parenteral antibiotic prophylaxis during colorectal operations is performed in a series of 32 patients, admitted on an emergency and deferred urgency basis, or for routine operative treatment. Of them 30 present malignant processes involving colon and rectum, and two--inflammatory diseases. All patients receive single i.v. injections with Cephalothin/Cefazolin at dose 2.0 g and Metronidazole 0.5 g immediately after anesthesia induction. In nine cases additional early treatment is necessitated--within 24 hours after the operative intervention--by administration of the same drug combination 4 times at 6-hour intervals, and in another two prophylaxis is substituted for continuous 5-day treatment using the same therapeutic scheme. In 30 patients the postoperative period runs a course free of noteworthy complications. In two instances there is evidence of operative wound suppuration, and in further two--urinary tract infection development unrelated to the antibiotic prophylaxis applied. The specific features characterizing the application of antibiotic prophylaxis during colorectal surgery are discussed, and appropriate drug therapy schemes are recommended, consistent with worldwide and Bulgarian experience along this line, as well as with the concrete hospital and economical conditions in this country. Special emphasis is laid on two aspects: optimization of the timing of antibiotic agent/agents injection, and reaching peak serum and tissue bactericidal concentrations in the immediate vicinity of the surgical incision; optimization of the duration of antibiotic prophylaxis on the ground of well established indications for the application of antibiotic prophylaxis in colorectal surgery in compliance with the dynamic patterns of intra- and postoperative septic risk. The modest number of patients subjected to updated parenteral perioperative antibiotic prophylaxis does not warrant a definitive interpretation of the data from the comparative clinical and pharmaco-economical analyses performed. Nevertheless, the preliminary results point to the economical expedience of the therapeutic approach suggested.

Volvulus of the small intestine is a condition of bowel obstruction due to knotting and twisting of the small intestine. Two types of volvulus are described: 1) primary small intestinal volvulus where no predisposing factors exist, and 2) secondary volvulus where congenital or acquired conditions promote twisting of the small intestine. Over a 5-year period, 18 patients (eleven men and seven women) presenting volvulus of the small intestine are operated in the Emergency Surgery Clinic of the University Hospital "Queen Giovanna", representing 8.7 per cent of the total of 206 cases of small intestinal mechanical ileus (incarcerated herniations involving the small intestine are not included in the series). Primary volvulus is found in one patient. In those presenting secondary volvulus adhesions are the commonest underlying cause of small intestinal rotation--13 cases, next ranking primary tumor of the small intestine--one case, Meckel's diverticulum--one, carcinosis of peritoneum--one, and one patient with small intestine volvulation around colostomy. The most frequently encountered symptoms and laboratory examinations performed are analyzed. Intestinal necrosis is established in four instances (22 per cent). One patient dies of peritonitis and polyorganic insufficiency. Volvulus of the small intestine should be mandatorily considered in patients presenting mechanical ileus of the small intestine. Early operative intervention is a therapeutic approach contributing to preclude intestinal necrosis.

Colorectal carcinoma is among the commonest cancer diseases of the alimentary canal in this country. The morbidity and mortality rates show an increase on an annual basis. A total of 1094 patients presenting colorectal carcinoma are analyzed over the period 1985 through 1996. In 690 cases (63.1 per cent) a complicated form of the basic disease is established. For the first time in this country, assessment of the total amount of bile acids in feces using thin-layer chromatography is done, as well as of cholesterol, beta-lipoproteins and triketosteroids in the serum. As shown by the investigations, there is a correlation between increased bile acid concentrations in the feces, decreased values of serum cholesterol, high concentrations of triketosteroids and severe dysbacteriosis, revealing in turn new aspects in the etiopathogenesis, early diagnosis and prophylaxis against colorectal carcinoma. The new principles of surgical management in complicated colorectal carcinoma improve considerably the 5-year survivorship, amounting to 22.1 per cent for T4.

Endoscopic sphincterotomy (ES) with extraction of calculi is a basic method of treating choledocholithiasis in post-cholecystectomy patients (8, 9). Endoscopic treatment contributes to a considerable reduction of the indications for reoperation. The existing views concerning ES done in patients with preserved gallbladder, especially in the era of laparoscopic surgery, are still conflicting (3, 6). There are several options: cholecystectomy with removal of calculi in the common bile duct by ES in a subsequent stage, or vice versa-primary ES with ensuring cholecystectomy. The undertaking of independent surgical or endoscopic treatment is likewise practicable (2, 6).

In the period 1990 through 1995, one-hundred patients operated for acute abdomen or admitted on a routine basis, presenting evidence of anaerobic infection, undergo treatment in the clinic of emergency surgery. Septic shock develops in 10/100 patients (10 per cent). In six of the latter the outcome is fatal--three with infection caused by spore-forming anaerobes (gas gangrene of the inguinal region--of Fournier, and anterior abdominal wall--anus praeternaturalis--two), and three with infection caused by non-spore-forming anaerobes (mixed anaerobic-aerobic infection). Anaerobic surgical infection and septic shock specificity is discussed, with an algorithm of therapeutic approach, based on clinical experience had with 100 patients, being proposed in either of them. Special emphasis is laid on antibiotic prophylaxis against anaerobic surgical infection. Its implementation in the concrete clinical conditions in this country demands a clearcut hospital drug policy (adoption of the "Drug Formularies" system), and elaboration of a new economical approach to the choice of antibacterial agents (using some of the forms of pharmaco-economical analysis, practicable with a view to the Bulgarian health-care model).

The introduction of intraoperative, and later postoperative cholangiography, results in the reduction of residual concrements in the bile ducts, but by no means in their total removal. Cholangioscopy was used as an alternative to this method (1, 5, 10). In 1923, J. Bakes employed a rigid choledoscope, and in 1970 J. M. Shore-a flexible one. Nowadays, technical improvement of the procedure makes possible to use cholangioscopy by one of two basic routes--transhepatic and peroral transpapillary (4, 6, 7, 9, 11). The former is recommended in the event of impossible or failing examination through papilla Vateri, or in the presence of stones and strictures within the intrahepatic bile ducts which cannot be reached by transpapillary route (4, 6, 9, 11). Peroral choledoscopy is used in clinical practice for a short time, and the early experience is still insufficient for definitive evaluation (2, 3, 7, 8, 9, 11).

Transendoscopic sclerotherapy of esophageal varix in children and adults is introduced in the clinic of emergency surgery ever since 1973. In children aged 3 to 14 years presenting preportal block a 100 per cent survivorship is recorded 20 years after the manipulation. The outcome of endoscopy in adult patients is successful in 57.69 per cent. Perilesional sclerosing is introduced in the CES in 1982, with a complete and definitive hemostasis attained in 46.7 per cent of the cases. In 1983, transendoscopic electrocoagulation is practically implemented in the CES, with the rate of successfully cured amounting to 55.49 per cent. Having in mind the limitations and contraindications of therapeutic transendoscopic hemostasis in massive hemorrhages, particularly those of ulcerative origin, preference is given to the safer hemostasis by surgical means.

After analyzing the summed up treatment results in 368 patients with acute cholecystitis, complicated by obstructive jaundice, the inference is reached that it is a matter of a complication, unfavourable in terms of prognosis, with a definite impact on both immediate and long-term therapeutic results. Early operative intervention following intensive preoperative preparation (including ERHPG with endoscopic papillosphincterotomy and ensuing biliary decompression, or echographic percutaneous cholecystectomy) contribute to control the acute inflammatory process in the gallbladder, and preclude the development of liver (or hepato-renal) failure against the background of obstructive jaundice. Proceeding from the severe, irreversible changes in liver and kidney, hardly responding to treatment, and persisting deterioration of the general condition, acute cholecystitis complicated by obstructive jaundice is defined as an emergency life-endangering condition, requiring a priority operative approach.

Based on a comprehensive literature survey, personal experience with the management of 89 patients, presenting acute noncalculous cholecystitis, is shared. All patients are clinically observed in the acute phase of the disease. In 60 cases the latter becomes manifest with recurrent attacks, and in 29 there are no previous signs or symptoms of biliary diseases. Diagnosis is made on the ground of active echographic and clinical observation. Conservative therapy is effective in 28 cases. The remainder (61) are operated at 1 to 4-day intervals after the onset of the disease because of persisting symptomatology and/or deterioration of the patient's condition. During laparotomy the gallbladder presents marked enlargement with thickened, exudate-imbibed wall. Cholecystectomy is done in all 61 cases. In twelve of them, owing to dilatation of the common bile duct and minimal serum bilirubin increase, stenosing papillitis is diagnosed by intraoperative cholangiography, treated by external biliary drainage and endoscopic sphincterotomy, undertaken after improvement of the general condition. Acute inflammation, free of fibrosis, with isolated foci of gangrene and necrosis of the bladder wall are histologically documented. In four senile patients presenting serious concomitant diseases, with exceptionally high operative risk, echographic percutaneous transhepatic cholecystectomy is resorted to, followed by antibiotic bladder instillations with a very good outcome. The summed up results of acute noncalculous cholecystitis treatment are estimated as very good.

Over an 8-year period, sixty-one patients with mean age 52.5 years are operated on for necrotic pancreatitis in the clinic of emergency surgery at the Faculty Hospital "Queen Giovanna"--Sofia. The initial prognosis of the severity of disease scores 4.5 points average according to Ronson's rating system. The indications for operative treatment are clinically determined and further specified by ultrasonographic echo-ranging and computerized axial tomography. Necrectomy associated with prolonged local postoperative lavage are used as a method considered the most adequate from tactical viewpoint. The criteria for this particular therapeutic approach are substantiated. At 19.6 per cent lethality the postoperative results are estimated as satisfactory, and fully consistent with worldwide experience along this line.

The clinical material summarized is derived from the observation of 150 patients. The accent is put on the faults in the X-ray interpretation of the pneumothorax and on the mistaken tactics in the treatment of the pneumothorax, which led to four lethal cases. The attention is drawn to the importance of the prompt physical study of traumatic patients, which gives the opportunity for prompt diagnosis and urgent adequate treatment. The indications have been precised relating pleurocentesis, pleural drain and when lacking aerostasis for thoracotomy.

This is a report on nine cases presenting biliary ileus. All patients undergo operative management. Two female patients present Bouveret's syndrome. The inference is reached that gallstone induced intestinal obstruction is characterized by atypical clinical patterns, conditioning in turn the diagnostic difficulties encountered, and the necessity to undertake operative treatment against the background of advanced ileus. The latter is one of the rarest forms of intestinal obstruction. Biliary ileus treatment consists in the removal of small intestinal impatency. The concretion is pushed in oral direction, and its evacuation is successfully accomplished by enterotomy, duodenotomy or gastrotomy. Two fatal outcomes due to severe advanced form of ileus are reported.

A review of the literature is made, in the attempt to establish the principles of the diagnosis and treatment in emergency surgery. They are listed as follows: 1. To preserve patient life and evaluate the functional capacity of the organism; 2. To establish emergency diagnosis; 3. To choose the method of treatment; 4. Method of operation. The guidelines in emergency surgery is to develop and perfect new methods of operation and new technical facilities, to raise the professional skill of the surgeon and to improve the organization of work in surgical clinics and departments.

Basic problem in all discussions on bleeding gastroduodenal ulcers is the one pertaining to the surgical tactics and to the ascertainment of the indications for surgical intervention and the time for its performance. Adequate answer to this question comes from recognition of the following points: 1. Endoscopically established bleeding source and intensity; 2. Considerations on other endoscopic criteria, clinical manifestations of bleeding--hematemesis, melena or both, changes in the controlled hemodynamic and hematologic parameters, as well evaluation of the accompanying diseases of major and secondary importance on the part of the cardiovascular and respiratory system; 3. Site and time of application of electrocoagulation and periulcer sclerosification in patients considered adequate for them, complying with the indications and contraindications; 4. Adequately chosen operative method. For the period 1985-1990 a total of 81 patients with bleeding from gastroduodenal ulcers, uncontrollable by conservative treatment, have been operated; 37 of them died (overall lethality 13.96 per cent, operative lethality 45.67 per cent). The choice of surgery depended on the localization, nature and extent of the pathologic process, the type and anatomical position of the pathologic focus, correlation with tissues adjacent to the pathologic process, presence of adhesions, callosity, etc. The method of choice was gastric resection by Billroth I, which was preferred to Billroth II resection. Other methods being used were: excision and pyloroplasty, excision, pyloroplasty + vagotomy, suture + vagotomy--mainly for ulcers localized on the anterior duodenal wall, suture, suture + vagotomy, ligation of a. gastrica sin., etc.

The authors report 24 cases with aggressive muscle-aponeurotic fibromatosis for the period 1985-1990. Eleven cases with proved fibrosarcoma have been studied as well. From the total 35 cases the authors have observed 5 cases with localization on the front abdominal wall in women, and the remaining cases are as follows: 9 patients with thoracic girdle (c. membri superioris); 9 patients--in the head area; 5--in the chest area; 12--in the limbs; 2--in the lumbar area.

On the basis of the experience and the analysis of 3818 cases of combined chest traumas the injuries in different anatomical areas have been observed. A special place was given for the diagnostics, the variety of the clinical conditions, the treatment and the prognosis of the reasons for lethality in cases with such traumas. With the increase of the affected anatomical areas the lethality increases proportionally too. At double, triple, fourfold, fivefold and sixfold combinations we have respectively 6.35 to 100% lethality. The indications for early surgical treatment have been stated. The acute respiratory failure (decompensation) and the shock in the combined traumas have been discusses as well.

Problems of the diagnosis, tactics and treatment of acute rectal hemorrhage are discussed. A diagnostic-tactical plan for determining the cause, source, localization and degree of bleeding are discussed. A diagnostic-tactical plan for determining the cause, source, localization and degree of bleeding, the acquired temporary or definitive hemostasis and the degree of blood loss is presented. Adequate approach to acute rectal hemorrhage helps to shorten the operation time, to reduce the extent of preoperative resuscitation and decrease total and operative lethality.

The authors report five cases with chordoma. The diagnosis has been determined histologically on the basis of the operative material. The chordomas have a slow growth and a tendency to infiltrate the adjacent tissues and organs. That makes their surgical treatment difficult. A characterizing feature for them is the tendency to make recidivations and the difficulty in setting the differential diagnosis in metastasis of light-cell carcinomas.

Twenty four patients with blunt trauma of the diaphragm comprise the study group. Four of them died of accompanying injuries in other anatomical regions. All patients had the left leaf of the diaphragm affected. Laceration was most frequently radial in the area of centrum tendineum or in the transition area to pars muscularis. In left-sided ruptures of the diaphragm protruded usually the stomach, left colon, spleen, omentum majus and seldomer small intestines. The clinical picture was multiform and depended mostly on the severity of the accompanying injuries and on the basic complications in ruptured diaphragm--incarceration and strangulation of the protruded abdominal organs. When rupture of the diaphragm is diagnosed operative treatment is as a rule mandatory. The surgical approach to left-sided ruptures of the diaphragm is the abdominal approach, because of the more frequent injury to the abdominal organs.

Over the period 1985 through 1992, forty-four patients presenting echinococcosis (echinococcus of the liver--33 cases, lung--nine, and spleen--two), aged 12 to 79 years, are operated in the emergency surgery clinic of the State Faculty Hospital "Queen Giovanna". The up-to-date methods of diagnosing are comprehensively described, followed by illustration and discussion of the operative procedures used in the treatment of echinococcosis. The early and long-term results are estimated as satisfactory.

Experience is recorded with lincomycin treatment of 59 patients with acute surgical abdomen. The primary anaerobic flora was eradicated in 86 per cent of the patients. For the very good therapeutic results essential was the early instituted adequate antibiotic therapy in adequate dose and for adequate length of time.

After a brief review of the literature the authors analyse the different invasive methods for treatment of liver metastases, rendering preference on intraarterial chemotherapy (IACT). The indications and contraindications for IACT and the possible complications of this approach are determined. The drugs for IACT, the types of implantable devices and the techniques for their application are shown. Criteria for assessment of the effect of treatment are determined. Experience is recorder with 3 patients with anterior resection of rectum and nonresectable liver metastases. The result was failure in 1 patient and very good in the other two.

A case is reported of primary malignant non-Hodgkin's lymphoma of the colon of a 85-year-old woman. The clinical manifestations and the X-ray pattern were those of cancer. The diagnosis was established on post-mortem examination. Histologically this was a centroblastic-centrocytic lymphoma of Brill-Symmers with low-grade malignancy. The clinical, diagnostic, prognostic and therapeutic problems in malignant non-Hodgkin's lymphomas of the colon are discussed.

A total of 2995 patients with esophagogastroduodenal bleeding have been treated the Department of Emergency Surgery for the period 1984-1988. A significant group were patients in advanced and senile age (beyond 65--42.4 per cent). The therapeutic and surgical approach to gastroduodenal bleeding was based on the solution of the following diagnostic-tactic problems: cause, source, localization and intensity of the bleeding, temporary or definitive hemostasis patterns, severity of blood loss. Essential is also the underlying disease, patient age and accompanying diseases. Express emergency endoscopy allows early and explicit visualization of the pathologic area and enables to gain knowledge on the nature and intensity of the bleeding or the character of spontaneous hemostasis. In this respect, express endoscopy is a guiding principle in managing upper digestive tract bleeding at the Department of Emergency Surgery. Of all hospitalized patients in this study were operated 203. Operations were performed after obligatory attempt for endoscopic hemostasis. The operative case fatality rate for the study period was, as follows: in gastric and duodenal ulcer 21.6 per cent, in gastric cancer 42.0 per cent, in hemorrhagic gastritis 33.3 per cent and in Mallory-Weiss syndrome 9.1 per cent.

Personal experience is recorded in the surgical treatment of 12 patients with gastric polyposis at the Department of Propaedeutics of Surgical Diseases of the Research Institute of Surgery, for a period of 10 years (1981-1990). They accounted for 75 per cent of the benign neoplasms of the stomach and 4.08 per cent of all gastric tumors. The results of operative treatment, both in patients treated by gastric resection according to Billroth I technique (58.3 per cent) and in patients who were treated only by removing the polyps (41.7% per cent) were considered good within a follow up period of 1 to 5 years after the intervention. Proceeding from modern achievements and reports in the literature, the authors place accent on some important current aspects of treatment and observation on gastric polyps, their correlation with a number of hyperplastic diseases and malignant neoplasms of the stomach and colon.

The study demonstrated that adenocarcinoma was the most common form of pancreas cancer. In the majority of cases it originated from the head of the gland, with the body ranking second and the tail third. Adenocarcinoma most frequently metastasized in the lymph nodes, less in the liver and rather infrequently in the lungs and intestines. When the cancer involved the entire gland or a greater part of it, metastases in the latter organs were practically obligatory. Most frequently metastases of pancreas adenocarcinoma were observed in the seventh decade, followed by the sixth and the eighth decades. This regularity as a whole matched the regularity of the age prevalence of pancreas cancer.

The authors analyzed a series of 421 patients with colorectal cancer after preliminary review of the current literature and the modern theories of the origin of the disease. The patients have been treated at the Department of Propedeutics of Surgical Diseases, Research Institute of Surgery, for the period 1984-1990, and special accent was placed on the study of the relation of colorectal cancer to cholelithiasis and cholecystectomy. It was shown that 1.19 per cent of all patients had been cholecystectomized at mean 10.6 years back and 6.65 per cent had pre-existing or accompanying biliary calculosis with mean duration of symptoms 16.4 years. A major relationship was found between morbidity from colorectal cancer, on the one hand, and patient sex and biliary calculosis, on the other. Eighty nine per cent of the patients with colorectal cancer and with biliary calculosis treated by cholecystectomy were women and 20.3 per cent of the women with colorectal cancer had biliary calculosis and had been cholecystectomized. Attention is focused on the current practical requirements of the prophylaxis of colorectal cancer--adequate attitude to biliary calculosis, feeding habits, specifying cases at risk and their observation.

Reviewing the literature, the authors discuss the diagnostic and surgical problems of abdominal adhesion disease in emergency surgery. The etiology and pathogenesis of adhesion disease is complex and still poorly understood. A number of etiologic factors are considered responsible. The authors formulate the current concepts on the pathogenesis of this disease and some classifications in the world literature. Adhesion disease is a major problem in emergency surgery, especially the form known as acute breed ileus. The prophylaxis, conservative and adequate operative treatment are of great importance.